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HelpTest Code TGSU Targeted Gabapentinoid and Stimulant High-Resolution Accurate Mass Spectrometry Screen, Random, Urine
Additional Testing Requirements
In most cases, no additional testing is needed after the qualitative targeted stimulant test is performed if the parent drug or metabolites found are consistent with the patient's prescribed medications. However, if an unexpected stimulant is found, confirmatory testing can be requested at an additional charge.
Specimen Required
Supplies: Sarstedt Aliquot Tube 5 mL (T914)
Collection Container/Tube: Plastic urine container
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative
Useful For
Determining compliance or identifying illicit stimulant drug use
This test is not intended for employment-related testing.
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| LPPS | List prescribed stimulants | No | Yes |
| TSIM | Gabapentinoid/Stim MS Screen, U | No | Yes |
Special Instructions
Method Name
Liquid Chromatography Tandem Mass Spectrometry, High-Resolution Accurate Mass (LC-MS/MS HRAM)
Reporting Name
Gabapentinoid/Stim HRMS Screen, USpecimen Type
UrineSpecimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Refrigerated (preferred) | 14 days |
| Frozen | 28 days |
Reject Due To
| Gross hemolysis | OK |
| Gross icterus | Reject |
Clinical Information
Stimulants are sympathomimetic amines that stimulate the central nervous system activity and, in part, suppress the appetite. Amphetamine and methamphetamine are also prescription drugs used in the treatment of narcolepsy and attention-deficit disorder/attention-deficit hyperactivity disorder (ADHD). Methylphenidate is another stimulant used to treat ADHD. Phentermine is indicated for the management of obesity. All other amphetamines (eg, methylenedioxymethamphetamine [MDMA]) are Drug Enforcement Administration scheduled Class I compounds. Due to their stimulant effects, the drugs are commonly sold illicitly and abused. Physiological symptoms associated with very high amounts of ingested amphetamine or methamphetamine include elevated blood pressure, dilated pupils, hyperthermia, convulsions, and acute amphetamine psychosis.
Gabapentinoids (pregabalin, gabapentin) are widely used in neurology, psychiatry, and primary care, with increasing reports of misuse. They decrease central neuronal excitability by binding to the calcium channel of hyperexcited neurons which results in a reduction in the release of excitatory molecules including glutamate and noradrenaline.
Gabapentin is not metabolized or protein bound and is primarily excreted and detectable in the urine for up to four days. Pregabalin is also largely excreted unchanged in the urine and detectable for up to 6 days.
Reference Values
Not detected (Positive results are reported with qualitative "Present" results)
Cutoff concentrations:
Methamphetamine: 100 ng/mL
Amphetamines: 100 ng/mL
3,4-Methylenedioxymethamphetamine (MDMA): 100 ng/mL
3,4-Methylenedioxy-N-ethylamphetamine (MDEA): 100 ng/mL
3,4-Methylenedioxyamphetamine (MDA): 100 ng/mL
Ephedrine: 100 ng/mL
Pseudoephedrine: 100 ng/mL
Phentermine: 100 ng/mL
Phencyclidine (PCP): 20 ng/mL
Methylphenidate: 20 ng/mL
Ritalinic acid: 100 ng/mL
Gabapentin: 500 ng/mL
Pregabalin: 500 ng/mL
Interpretation
If a stimulant or its corresponding metabolite is identified (present), it indicates that the patient has used the respective stimulant in the recent past (typically 1-3 days). If a gabapentinoid is identified, it indicates that the patient has used the respective drug in the recent past (1-6 days).
The absence of the expected stimulant or its metabolites or gabapentinoid may indicate noncompliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted or adulterated urine, or limitations of testing. The concentration of the drug must be greater than or equal to the cutoff to be reported as present. If a specific drug concentration is required, the laboratory must be contacted within 2 weeks of specimen collection/testing to request quantification by a second analytical technique at an additional charge.
Cautions
No significant cautionary statements
Clinical Reference
1. Jannetto PJ, Bratanow NC, Clark WA, et al. Executive Summary: American Association of Clinical Chemistry Laboratory Medicine Practice Guideline-using clinical laboratory tests to monitor drug therapy in pain management patients. J Appl Lab Med. 2018;2(4):489-526
2. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 43
3. McMillin GA, Marin SJ, Johnson-Davis KL, Lawlor BG, Strathmann FG. A hybrid approach to urine drug testing using high-resolution mass spectrometry and select immunoassays. Am J Clin Pathol. 2015;143(2):234-240
4. Paterson SM, Moore GA, Florkowski CM, George PM. Determination of methylphenidate and its metabolite ritalinic acid in urine by liquid chromatography/tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2012;881-882:20-26
5. Cone EJ, Caplan YH, Black DL, Robert T, Moser F. Urine drug testing of chronic pain patients: licit and illicit drug patterns. J Anal Toxicol. 2008;32(8):530-543
6. Cheze M, Deveaux M, Martin C, Lhermitte M, Pepin G. Simultaneous analysis of six amphetamines and analogues in hair, blood and urine by LC-ESI-MS/MS. Application to the determination of MDMA after low ecstasy intake. Forensic Sci Int. 2007;170(2-3):100-104
7. Concheiro M, Simoes SM, Quintela O, et al. Fast LC–MS/MS method for the determination of amphetamine, methamphetamine, MDA, MDMA, MDEA, MBDB and PMA in urine. Forensic Sci Int. 2007;171(1):44-51. doi:10.1016/j.forsciint.2006.10.004
8. Rovine T, Ferrero CL, American Pain Society. Chronic Pain in America: Roadblocks to Relief. Roper Starch Worldwide, Inc; 1999. Updated October 2, 2001. Accessed September 8, 2026. Available at http://accurateclinic.com/wp-content/uploads/2016/04/Chronic-Pain-In-America-Roadblocks-To-Relief-1999.pdf
9. Bost RO. 3,4-Methylenedioxymethamphetamine (MDMA) and other amphetamine derivatives. J Forensic Sci. 1988;33(2):576-587
Method Description
The urine sample is diluted with internal standard and clinical laboratory reagent water and then analyzed by liquid chromatography tandem mass spectrometry using a high-resolution accurate mass orbitrap detector.(Unpublished Mayo method)
Day(s) Performed
Monday through Sunday
Report Available
3 to 4 daysSpecimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
G0480
80326 (if appropriate for select payers)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| TGSU | Gabapentinoid/Stim HRMS Screen, U | 99107-5 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| LPPS | List prescribed stimulants | 29305-0 |
| 624198 | Methamphetamine | 19554-5 |
| 624199 | Amphetamine | 19343-3 |
| 624200 | 3,4-methylenedioxymethamphetamine (MDMA) | 19568-5 |
| 624201 | 3,4-methylenedioxy-N-ethylamphetamine (MDEA) | 59844-1 |
| 624202 | 3,4-methylenedioxyamphetamine (MDA) | 19565-1 |
| 624203 | Ephedrine | 99108-3 |
| 624204 | Pseudoephedrine | 99109-1 |
| 624205 | Phentermine | 19674-1 |
| 624206 | Phencyclidine (PCP) | 19659-2 |
| 624207 | Methylphenidate | 19577-6 |
| 624208 | Ritalinic acid | 99110-9 |
| 624209 | Gabapentin | 68439-9 |
| 624210 | Pregabalin | 105953-4 |
| 624211 | Stimulant Interpretation | 54247-2 |